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Int Psychogeriatr. 2018 Oct;30(10):1549-1555. doi: 10.1017/S104161021800025X. Epub 2018 Apr 4.

Correlates of nursing care burden among institutionalized patients with dementia.

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Department of Psychiatry,The Second Xianga Hospital,Central South University;China National Clinical Research Center on Mental Health Disorders (Xiangya);China National Technology Institute on Mental Disorders;Hunan Technology Institute of Psychiatry;Hunan Key Laboratory of Psychiatry and Mental Health;Mental Health Institute of Central South University,Changsha,Hunan,China.
Private Practice in Neuropsychology,Waterloo,Canada.
Department of Psychology,Ryerson University,Toronto,Canada.
Department of Psychiatry,Singapore General Hospital,Singapore.
Division of Geriatric Psychiatry,Department of Psychiatry,Sunnybrook Health Sciences Centre,Toronto,Canada.


ABSTRACTBackground:The stress associated with care of patients with dementia has led to high nursing staff turnover. This study aims to explore patient factors that are related to nursing burden.


The present study examined nursing care burden related to 55 institutionalized dementia patients using the Modified Nursing Care Assessment Scale (M-NCAS). Cognition was assessed with the Severe Impairment Battery (SIB), activities of daily living (ADLs) were measured with the Alzheimer's Disease Functional Assessment of Change Scale (ADFACS), aggression was measured with the Aggressive Behavior Scale (ABS), and the Charlson Comorbidity Index (CCI) was used to assess medical comorbidity. Finally, the Dementia Cognitive Fluctuation Scale (DCFS) was used to assess the presence and severity of cognitive fluctuations (CFs). Linear regression models were used to assess their relationships with nursing care burden.


The mean age of the patients was 90.41 years (SD=2.84) and 89.10% were males. ADFACS total score (B = 0.36, β = 0.42, p = 0.002) and ABS score (B = 2.933, β = 0.37, p = 0.002) significantly predicted the M-NCAS Attitude score. ABS score was the only significant predictor of M-NCAS Strain score (B = 2.57, β = 0.35, p = 0.009).


In the long-term care setting, aggressive behavior plays an important role in both subjective and objective nursing burden, while impaired ADLs increase the objective burden for nursing staff.


activities of daily living; aggressive behavior; cognitive fluctuations; dementia; nursing burden

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